During surgery or for follow-up to determine the present functionality or to change functionality for implanted medical devices, it can be important for an expert at a remote site to know how the implant is responding and what the local actor dealing with the implant and/or the patient is doing in real time. There is very little acceptance for confusion in such circumstances and having a real time system display available to both the remote actor and the local actor will go a long way to eliminating the potential for confusion.
Similar communications and remote functioning have been attempted previously. It is believed that none of the prior systems are particularly well suited to the surgical or clinical environments, and particularly not to those where implanted medical devices are being used. By enabling remote pointing and physiologic display coordination, rapid and exact communications about the condition of the device and/or the patient and any peculiarities in the display can be noted and controlled for across large distances. Thus a single expert could be "virtually" at many distant locations in a single day using such a system without leaving the situs of his computer. A list of references where similar inventions in the same or other fields were contemplated follows, and these are incorporated herein by this reference thereto.
Epard et al, U.S. Pat. No. 5,241,625, PA1 Inga et al., U.S. Pat. No. 5,384,643, PA1 Thompson U.S. Pat. No. 4,377,852, PA1 Ziv-El U.S. Pat. No. 5,263,869, PA1 Thessin et al. U.S. Pat. No. 5,452,299, PA1 Harlan U.S. Pat. No. 5,168,269, PA1 Torok, et al. U.S. Pat. No. 4,317,956, PA1 Stein et al. U.S. Pat. No. 4,098,267, and PA1 Bijnagte U.S. Pat. No. 5,235,680.
There have been remote device operations used before, wherein a remote expert could control what was occurring on a local technicians station, including for example, the model 89441a Vector Signal Analyzer.TM. from Hewlett Packard, but no prior devices of which the inventors are aware include the features of this disclosure which are particularly suited to remote expert supervision of a local implantable medical device operation. The instant disclosure relates particularly to allowing for repeatable remote near real time ECG, EGM, and marker channel information at the same time display and allowing for dual site manipulation of a pointer on the display at both locations without having conflict. [In this document we will use various terms such as ECG, EGM, EKG and Marker Channel information to represent that such types of information as the intracardiac electrogram or surface ECG's, with or without additional marker channel information are all signals that could be found in the display window for whatever physiologic signal that the local attendant and remote expert may desire to look at simultaneously. Accordingly, any such use of these terms should be assumed to apply to the use of any of these terms for any similar physiologic signals, with or without device information superimposed thereon, such as Marker Channel information.]
The primary use of the invention is believed to be pacemaker/defibrillator follow-up and implant where an expert is remote from the patient's local situs where such operations are occurring. What is believed to be needed is a communications system for communicating in real time or near real time the position of a pointer that is manipulable at more than one location on simultaneous displays at two locations so that the pointer will appear at the same location in the remote display as the local display regardless of any conflicting instructions given by users at the remote and local locations. Provision is made to allow for simultaneous activation of two pointers, one controlled by the expert and one by the attending technician/physician. Each has a unique icon in our preferred system embodiment.
This system should have simultaneous displays for communicating and where necessary, enhancing the ECG signal available for remote display such that it appears to move like a normal ECG at the remote location with minimal difficulty and movement occurs n near real time. Of particular concern in using typical remote viewing systems is that screen displays occasionally have lossy displays, so a short term change in a physiologic signal may be missed at the remote location. The sweep-bar or smooth movement of the signal should ideally be maintained. The availability of such a system would help a great deal in surgery and particularly cardiac surgery. It could also find application to the cardiac pacemaker clinic follow up. With a coordinated cursor or pointer only one of the remote and local actors can adjust its position at a given moment, and there can be no confusion as to what location in the display they are both communicating about through some other telephonic aural or video link which should be operative simultaneously to best employ the inventive features described herein.
What such a system would enable is the review by an expert on either the patient (as in a doctor, for example) without this expert needing to be present in real space. It alternatively and simultaneously could be used for the consultation of a local physician or surgeon with a systems expert that may have intimate knowledge about the components of the devices that are generating the EKG signal and performing other functions in the surgical or clinical locality.